Free Illinois Affidavit and Certificate of Correction Request Form - PDF Form Download

Illinois Affidavit and Certificate of Correction Request Form Overall rating: ☆☆☆☆☆ 0 based on 0 reviews

51

State Of Illinois Affidavit and Certificate of Correction Request is the legal document for requesting amendment in the record of a child due to the error in the records held by the State of Illinois.

The document must be signed before the Notary Public of the state for its acceptance. Submit the duly completed Affidavit and Certificate of Correction Request to Illinois Department of Public Health, Division of Vital Records, 925 E. Ridgely Ave., Springfield, IL 62702-2737. Remittance of $15 fees by check or money order to Illinois Department of Public Health is required for the processing the request. Attach a copy of a government ID proof along with the request form.

Before You Proceed

Use black colored ink to type or print the inputs in the Affidavit and Certificate of Correction Request.

Check mark on the record to be corrected is necessary.

Avoid using whiteouts, alterations, and cross outs to prevent voiding of the Affidavit and Certificate of Correction Request.

Notarization and remittance of $15 fees are necessary for the post processing of the Affidavit and Certificate of Correction Request after its submission with Illinois Department of Public Health.

Complete the Affidavit and Certificate of Correction Request in every sense to avoid ambiguity, delay, as well as rejection of processing.

Do not write/type/print in the last portion of the Affidavit and Certificate of Correction Request. This space is reserved for the inputs by the officials of Division of Vital Records, Illinois Department of Public Health

Begin by marking your choice of correction from the three options listed on the foremost portion of the document. Continue by typing or printing your legal name followed by the relationship. Specify the relationship as appropriate.

The first section of the Affidavit and Certificate of Correction Request requires the input of the name currently on the record. Enter the place of birth or death on the following line. Enter the date of birth or death in the space provided for the same. Enter the names of mother and father and/or co-parent/s in the respective spaces provided for the name. Take care to enter the legal names prior to the first marriage/civil union.

The Second section of the Affidavit and Certificate of Correction Request requires the input of what you need to correct, how it reads now, and how it should read. Mention each correction on a separate line and use one more affidavit/request form if more space is required.

Enter the street address, city, state, and zip code of the applicant in section 3 of the Affidavit and Certificate of Correction Request. Continue by typing the date and sign in the space provided on the next line.

The following space is reserved for notarization and requires the inputs by the Notary Public of Illinois State.

Do not type or print in the last portion of the Affidavit and Certificate of Correction Request. It is reserved for official use.